Emergencies
Tremors, jitteriness, irritability, weak or high-pitched cry, lethargy, hypotonia, cyanosis, apnea, hypothermia, and poor feeding are all nonspecific signs of this newborn emergency that requires immediate intervention.
What is symptomatic hypoglycemia?
A reading over 14 mg/dL, or within 2 mg/dL of the phototherapy treatment threshold, requires this lab to be drawn.
What is Total Serum Bilirubin?
This injection is given to an Rh-negative mother after delivery of an Rh-positive baby to prevent antibody formation.
What is Rho(D) immune globulin (RhoGAM)?
During a postpartum hemorrhage, this is how often vital signs must be cycled and documented.
What is every 1–5 minutes?
On the ObsQoR-10 (QRS), which evaluates maternal quality of recovery after childbirth, this threshold score is associated with delayed or poor postpartum recovery.
What is a score of less than 60?
This routine task, completed hourly during the day and every 1-2 hours at night, must be documented in the “Safety” section under the “Daily Cares/Safety” tab.
What is hourly rounding?
Change in level of consciousness, shortness of breath, respiratory depression, loss of deep tendon reflexes, hypotension, chest pain, ECG changes, and diminished urine output are warning signs of this life-threatening complication in patients receiving magnesium sulfate.
What is magnesium toxicity?
After three doses of dextrose gel or two consecutive point-of-care glucose readings below 45 mg/dL, this confirmatory test must be obtained in the newborn.
What is a serum blood glucose?
After delivery of a Rh-positive baby, this test is ordered on a Rh-negative mother to measure the number of fetal red blood cells in her circulation and determine if she will require an additional dose of Rho(D) immune globulin.
What is the Kleihauer-Betke test (KBS)?
Post-treatment, this obstetric emergency requires vital sign monitoring every 10 minutes for 1 hour, then every 15 minutes for 1 hour, every 30 minutes for 1 hour, and finally every hour ×4.
What is acute-onset severe hypertension?
This postpartum assessment focuses on the fundus, perineum, breasts/nipples, and surgical site, and must be documented within 1 hour of admission, within 2 hours of handoff, and at least every 8 hours.
What is a maternal targeted (focused) assessment?
This education topic must be documented once per shift in the “Maternity -Postpartum Education” column and appears in three sections: Plan of Care First 24 Hours, Next Days, and Discharge.
What is “incision care”?
If a patient has 2 or more of the following, oral temperature <36 °C or ≥38 °C, heart rate >110 bpm, respiratory rate >24, WBC <4,000 or >15,000, or >10% bands, you must notify the provider immediately, as these may indicate this serious condition.
What is sepsis?
Because of risks such as twin-to-twin transfusion or unequal placental sharing, this lab should be drawn in twin newborns to evaluate for anemia (<40%) or polycythemia (>65%).
What is a hematocrit?
Back or chest pain, hypotension, dyspnea, hives, nausea, fever, chills, dizziness, swelling, hematuria, oliguria occurring during or after administration of blood products may indicate this complication that requires immediate intervention.
What is a blood transfusion reaction?
Performed before the first postpartum ambulation, these must be repeated with each ambulation if initially positive (until negative or order placed to discontinue), or if the patient develops dizziness, lightheadedness, or increased bleeding.
What are orthostatic vital signs?
According to the “Perinatal Inpatient - Postpartum Hemorrhage” policy, this is the required frequency of vital signs and OB-focused assessments (including fundal and lochia checks) for a stable PPH patient admitted to Postpartum.
What is within 15 minutes of admission, every 30 minutes ×1, every 2 hours ×1, every 4 hours ×2, and then every 8 hours for 24 hours?
This is the timeframe in which a critical lab value must be reported and documented under provider notification.
What is within 60 minutes?
Common symptoms of this obstetric emergency include dyspnea, chest pain, hemoptysis, fever, tachypnea, tachycardia, cyanosis, hypotension, and cardiovascular collapse.
What is a pulmonary embolism?
This lab should remain between 4.8 and 8.4 mg/dL when given therapeutically; values below 4.8 or above 8.0 require immediate provider notification.
What is the therapeutic serum magnesium level?
To avoid unnecessary use of emergency group O or uncrossmatched blood, this specimen must be drawn and sent stat to the Stanford Main Transfusion Service if the prior sample is expired or a confirmatory one has not yet been collected.
What is a type and screen?
During a blood transfusion, vital signs must be checked and documented within this time frame
What is within 1 hr before start, 15 min after start, and within 1 hr post completion?
Frequency in which a comprehensive (full head-to-toe) postpartum assessment must be documented.
What is within 2 hours of admission/transfer/handoff, and at least once every 12 hours
Per policy, providers must be notified whenever these fall outside ordered parameters. They must be promptly rechecked, escalated by the primary RN, reported even if normal on recheck, and documented under provider notification.
What are abnormal vital signs?
This severe form of preeclampsia is diagnosed when LDH is ≥600 IU/L, AST/ALT are more than twice the upper limit of normal, and platelet count is <100,000. Women may present with right upper quadrant pain, malaise, nausea, or vomiting. Proteinuria and hypertension may or may not be present, which can delay recognition.
What is HELLP syndrome?
With critical thresholds of >2 mmol/L when not in labor and >4 mmol/L during labor, this lab helps gauge the severity of infection.
What is lactic acid?
To pick up emergency blood for an MTG, the runner must present one of these two items.
What is a patient label with two identifiers (Name and MRN and/or DOB), or a signed Emergency Release of Blood Products form and call slip with patient identifying information?
According to the Perinatal Inpatient: Postpartum Nursing Standards of Care, this is how often maternal vital signs (including pain) must be documented following admission, transfer, and handoff.
What is within the first hour, and at least every 8 hours thereafter (completed more often as ordered)?
According to the “Perinatal Inpatient: Newborn Nursery Nursing Standards of Care,” this is how often newborns must have a full head-to-toe assessment (including vital signs, pain, and comfort) completed and documented.
What is within 2 hours of admission, every 8 hours thereafter, and every shift (within the first 2 hours)?
This flowsheet tab contains all the required components for hourly documentation of a patient on Magnesium.
What is the “HTN of Pregnancy” tab?